Factors associated with the phenomenon of overcrowding in the emergency
department: a retrospective cohort study

Factors associated with the phenomenon of overcrowding in the emergency
department: a retrospective cohort study

Emergency medical services, Overcrowding, Emergency room visits, Emergency services, Hospital/trends,
Health services accessibility

Objectives Emergency departments (EDs) have been confronted with growing demand for several decades.
However, the strain on EDs is generally not evenly distributed across the year, as some days are at increased risk
of overcrowding compared to others. Identifying the days during which teams are unable to meet actual service
demands could be beneficial as a means to avoid, in the most drastic cases, redirecting patients to other care
structures (ambulance diversion). The objective of this study was to identify the factors explaining ED overcrowding in
a general hospital.
Methods We conducted a retrospective study at a single emergency department between 1 January 2017 and 31
December 2021. The days with the highest deviation from baseline regarding length of stay were defined as being
overcrowded. The factors associated with overcrowding were evaluated using a logistic regression model adjusted for
the day’s characteristics.
Results The study period comprised 183 overcrowded days and 1643 uncrowded days. The factors associated
with the risk of crowding in multivariable analysis were the ED crowding status of the previous day, the number of
patients at the beginning of the day, the proportion of patients age 75 or greater, the number of radiological exams
per patient, and the number of radiological exams of the skull and brain region. The mitigating factors were the
proportion of patients with less urgent needs during triage, an increased proportion of patients needing trauma care,
the proportion of patients<7 years old, weekend days, and the epidemic period following the month of March 2020.
Conclusion Our study has highlighted case-mix factors and chronological factors related to the risk of overcrowding.
These factors were communicated to hospital management, which allowed the hospital to reassess its operations.

Jan Chrusciel1

, Adrien Wartelle2

, Antoine Sanchez3

, Marine Desbouvry4

, Amélie Brochet-Paille5

, David Laplanche1

and Stéphane Sanchez1,6*

https://doi.org/10.1186/s12873-025-01460-0

2026

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